“Is it 2 breastfeeds and then a bottle, or is it one breastfeed and a bottle? Not sure”? Women’s experiences of breastfeeding their Late Preterm Babies
Authors: Cescutti-Butler, L.
Start date: 12 June 2017
This presentation will report on women’s experiences of breastfeeding their late preterm baby/babies (LPBs), born between 340/7 and 36 6/7 weeks gestation. These women’s experiences are especially relevant to explore as the number of babies born late preterm is rising. Traditionally, woman-mothers and their LPBs have been studied under the umbrella of the general preterm population, with all experiences extrapolated from within this group. Whilst there is a growing body of literature related to LPBs, the focus is on physiology and physical needs. There is minimal research exploring women's experiences of breastfeeding LPBs and their views are largely unknown. My aim was to privilege women's experiences, therefore a feminist approach to research was utilised which enabled an opportunity to understand the world of women who care for LPBs, and what I learned from their experiences. To obtain in depth perspectives, individual qualitative interviews were carried out in two phases, with a purposefully selected sample of fourteen women who were caring for LPBs. Template Analysis linked to Birth Territory Theory was utilised to identify key issues. Many of the women revealed that infant feeding was an important part of their experience with some claiming that feeding support was ‘hit and miss’. My findings further demonstrated that breast feeding was controlled and evaluated on the basis of two practices: schedules and weighing. Scheduled feeding as opposed to flexible feeding has been proposed, as LPBs have a propensity to sleep for many hours. However, feeding flexibility may cause a baby to fall behind in its daily requirements due to sleepiness and/or poor feeding techniques, resulting in a less than optimal weight gain. Whilst feeding regimes prescribed by medical authority appear to be of benefit to LPBs, strict feeding schedules work against mothering in two ways. Firstly, it increases women’s mother-work when breastfeeding, as they are required to produce a certain amount of milk at fixed points in time, and secondly, alarm clock feeding goes against women’s ‘mothering’ instincts and reinforces the ideology of scientific motherhood (Apple 1995). For the women in my study, breastfeeding was hard work. Their experiences were further influenced by a postnatal environment that was industrial in purpose and where women were producers of a product (breastmilk) and their babies recipients of that product (Dykes 2006). What eventually became apparent to the women was that going home was incumbent on their baby/babies gaining weight, which was the reward for good mothering. To get to that point however, they had to follow feeding policies based on preterm fragility and women appeared, at least initially, unable to influence any aspect of their baby’s feeding except to enforce the regime as stipulated by healthcare professionals. Feeding instructions were didactic and strictly enforced with women having no choice but to follow orders. Professional advice was deemed ‘authoritative’ (Murphy 2003) and women appeared powerless to alter the course of events, even when intuitively, they felt their babies were being overfed. So, whilst on the one hand they appeared to value ‘scientific-based advice’, women were somewhat bewildered when, at times, their knowledge and common sense was in conflict with “expert opinion” (Apple 1995).
This study has demonstrated that women caring for LPBs frequently encountered contradictory advice regarding breastfeeding and often felt their own experiences, intuition and instincts were devalued. Therefore my research concludes that the practice of breastfeeding LPBs should be revisited in partnership with women, so their experiences and perspectives can be utilised to develop satisfying nurturing relationships whilst also meeting nutritional requirements. Apple R. D. (1995) Constructing mothers: scientific motherhood in the nineteenth and twentieth centuries. Social history of medicine [online], 8 (2), 161-178.
Dykes F. (2006) Breastfeeding in hospital: mothers, midwives and the production line [online]. London: Routledge.
Murphy E. (2003) Expertise and forms of knowledge in the government of families. Sociological review [online], 51 (4), 433-462.